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In this randomized controlled trial, the effect of OS on bone material strength index (BMSi) in older women was non-inferior to that of DME. No significant interaction between treatment and time was observed in any measured outcomes, indicating no meaningful difference between the intervention groups. Although the OsteoStrong\u00ae intervention met the pre-specified non-inferiority margin compared to the DME group, the lack of efficacy of the DME intervention on BMSi limits the interpretation of this finding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to investigate whether the effect of using OS was non-inferior to DME for the primary outcome of BMSi in older women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Women aged 65\u201379\u00a0years with osteopenia or osteoporosis were randomized to 9 months of once-weekly OS (20\u00a0min) or twice-weekly DME (60\u00a0min\/session). A total of 194 women (OS, 97; DME, 97), median age 70\u00a0years, participated in the trial. The primary outcome was BMSi measured with impact microindentation at the tibia. A pre-specified non-inferiority margin of BMSi \u22125.2 was applied to determine whether the intervention\u2019s efficacy was not clinically worse than the comparator within an acceptable threshold. The secondary outcomes were bone mineral density (BMD) and bone markers (S-CTX, S-P1NP, S-BALP, and S-sclerostin).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At the 9-month follow-up, there were no significant differences between the groups in any of the outcomes. The mean between\u2011group difference in BMSi was 1.16, with a 95% confidence interval ranging from \u2212\u20091.51 to 3.82. Since the lower limit of the confidence interval (\u2212\u20091.51) did not cross the predefined non\u2011inferiority margin of \u2212\u20095.2, non\u2011inferiority was established. There was a significant increase in BMSi by 2.9% in the OS group (from 73.9\u2009\u00b1\u20099.5 to 76\u2009\u00b1\u20099.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025), and lumbar spine BMD by 0.8% in the DME group (from 0.866\u00a0g\/cm\n                      <jats:sup>2<\/jats:sup>\n                      \u2009\u00b1\u20090.13 to 0.872\u00a0g\/cm\n                      <jats:sup>2<\/jats:sup>\n                      \u2009\u00b1\u20090.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016). Changes in femoral neck BMD were not significant. There were no significant within- or between-group differences in any of the bone markers at 3 and 9 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on these findings, the effect of OsteoStrong\u00ae on BMSi in older women was non-inferior to that of dynamic multicomponent exercise. No significant interaction between treatment and time was observed in any measured outcomes, indicating no meaningful difference between the intervention groups. Although the OsteoStrong\u00ae intervention met the pre-specified non-inferiority margin compared to the DME group, the lack of efficacy of the DME intervention on BMSi limits the interpretation of this finding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-026-01679-9","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T19:40:09Z","timestamp":1772134809000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of OsteoStrong compared to dynamic multicomponent exercise on bone strength in older women: the BONEMORE non-inferiority randomized controlled trial"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3087-0384","authenticated-orcid":false,"given":"Peter W. 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